Healthcare Provider Details

I. General information

NPI: 1508394834
Provider Name (Legal Business Name): CT PSYCHOLOGICAL CONSULTING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2017
Last Update Date: 05/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 WETHERSFIELD AVE FL 2
HARTFORD CT
06114-1113
US

IV. Provider business mailing address

PO BOX 11
HARTFORD CT
06141-0011
US

V. Phone/Fax

Practice location:
  • Phone: 860-578-4779
  • Fax:
Mailing address:
  • Phone: 860-578-4779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number003043
License Number StateCT

VIII. Authorized Official

Name: LASHANDA B HARVEY
Title or Position: OWNER
Credential: PSY.D
Phone: 860-578-4779